Bulimia nervosa is an eating disorder (ED) characterized by the following:

  • Recurrent binge eating episodes with rapid consumption of large amounts of food in discrete periods of time (approximately 2 hours)
  • Feeling of lack of control over eating behavior during eating binges
  • Compensatory behaviors such as self-induced vomiting, laxative or diuretic use, strict dieting, or vigorous exercise
  • Minimum average of one binge eating/compensatory behavior episode per week for at least 3 months
  • Associated feelings of guilt, shame, low self-esteem, and depression
  • Persistent overconcern with body shape and weight
  • Symptoms and psychopathology may overlap with anorexia nervosa, but bulimia does not occur exclusively during episodes of anorexia nervosa.


  • Onset in adolescence to young adulthood
  • Approximately 10:1 female-to-male ratio
  • 70% of the adolescents who meet criteria for full and partial syndrome eating disorders also meet criteria for an Axis I disorder.


  • Adolescents have a 1–1.5% 12-month prevalence of bulimia according to the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5).
  • Up to 25% of college-aged women use bingeing and purging as a weight management technique.
  • Bulimia nervosa prevalence rates in Western countries for females range from 0.3% to 7.3%.

Risk Factors


Recent studies, including twin studies, suggest that bulimia nervosa and binge eating may have a genetic vulnerability and familial transmission.

General Prevention

  • Emphasize healthy self-esteem/body image with preadolescents and adolescents.
  • Regular family dinners may have some protective effect against eating disorders.


  • Personality traits of low self-esteem, self-regulatory difficulties, frustration, intolerance, and impaired ability to recognize and express feelings directly described in bulimia nervosa
  • Small positive association between childhood sexual abuse and eating disorders but size and nature of this association not known
  • Neuroendocrine abnormalities may also play a role: Abnormalities in serotonergic and vagal function have been demonstrated in patients with bulimia nervosa.
  • Cholecystokinin response to a meal is decreased in bulimia nervosa, which may also indicate abnormal satiety signaling.
  • May be abnormalities in other hormones or neurotransmitters such as leptin, dopamine, and endorphins; unclear if cause or effect

Commonly Associated Conditions

  • Mood lability, impulsivity, and emotional dysregulation are common in patients with bulimia or subthreshold bulimia.
  • Lifetime rates of major depressive disorder in individuals with eating disorders 50–75%
  • In adolescents, bulimia is associated with persistent depressive disorder, (formerly known as dysthymia), more than major depression.
  • 63.5% of bulimic patients have lifetime history of an anxiety disorder.

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